Nursing is an ethically related practice. Ethical issues are becoming varied and complex in nursing because of medical advances as well as the complexities in the health system. The nursing field is full of increased challenges that critically impact the work of nurses. All the areas of the nurse’s practice are faced with ethical dilemmas that impact the patients, the health care institution, and the society. However, nurses have the responsibility of acting ethically regardless of these challenges. They have to choose between two alternatives while providing quality care. The reason is the society expects nurses to act ethically as they practice. Social expectations of a good nurse are changing with the times. Nurses are patients’ advocates, thus have to make ethical decisions to support their patients during daily practice. With the society in mind, nurses have to make ethical decisions regarding patient care to be able to understand and identify ethical issues during nursing practice. The aim of this paper is to determine the ethical issues in nursing and to explore the factors that influence the dilemmas, providing strategies to counter the challenges.
Ethical problems in nursing are challenging issues that require a moral solution. The moral problem arises when the situation, in which the dilemma occurs, is between the nurse’s values and the norms of other people. Notably, nurses need to make choices on the basis of what is fundamentally right according to the principles of nursing. An ethical problem-solving is an essential part of nursing management (Park et al. 594-595). There are numerous ethical issues that nurses encounter in their workplace. Some of them are quality versus quantity of patient life, pro-choice or pro-life, freedom against control, truth or deception, to use empirical knowledge or personal belief and how to distribute resources. Other ethical issues that nurses face are cultural diversity. Also, caring for people with different traditions and accepting their rituals as well as values is extremely challenging. To ensure access to care for all patients by ensuring affordability and equity can sometimes cause ethical challenges to nurses.
Quantity addresses the period the patient may live or the persons affected by any decision. On the other hand, quality entails good life of a patient depending on its definition. With the two definitions, the nurse faces difficulty in deciding the best options to take in the patient care. Some therapies can prolong life but compromise the quality of patient’s life. A patient may live longer but may experience major side effects due to the therapy. Pro-choice against pro-life comes into play as the issues affect the decisions of the nurse (Park et al. 596). Nurses assume many positions, mostly based on their values and beliefs. For instance, a nurse may not support abortion, but finds that caring for a patient who has aborted. In this case, the nurse has to support the patient, although both have opposing values.
Freedom versus control is another issue that nurses face. It is the patients’ right to make choices regarding their health. However, in some instances they make choices that eventually harm them. Can the nurse prevent or allow such decisions? Another issue that nurses have to deal with is choosing to tell the truth or not. The situation occurs when the family members request the nurse not to tell the patient about the real medical condition he or she is suffering. Patients have the right to know everything regarding their medical condition; however, the information can cause them harm. Nurses are concerned that sometimes patients are not fully informed about their condition and the treatment options (Park et al. 597). Additionally, the doctors or clinicians may not present the patient’s voice in the prognosis. Most often, clinicians do not follow the wish of the patient due to family demands.
Nurses find it challenging to distribute limited resources to the needy patients in the hospital. The decision to choose the neediest patient is left to them, thus sometimes becoming an ethical problem. However, family members may plead that the life support should be used for a medically ineffective patient. The nurse may be forced to consider the cost of maintaining these machines and the lives that could be saved in making decisions. Conversely, the nurse is left with the choice of using empirical knowledge or useing her or his personal beliefs. In some instances, research-based knowledge is sometimes contrasted to beliefs, specifically the religious ones (Butts and Karen 5-7). There are patients who do not accept blood transfusions due to their religious beliefs. However, their condition may desperately need the transfusion to save their lives. The nurse is expected to empathize with the patient, but save the life of this patient as it is his or her right.
Nurses frequently report distresses regarding discomfort in patients, informed consent and having to work further than the common goal. Moral distress comes about when nurses are limited to act in a manner they find right. The American Nurses Association has to respond to its members in dealing with ethical concerns. The top three issues that the association has to deal with are integrating the work environment, genetics, and genomics into practice, mostly, when dealing with palliative care and end-of-life issues. Regarding the work environment, nurses have to report any difficulties in the workplace and any environmental and ethical concerns. The work of ethics is to allow a dialog. Staffing issues as well as patient safety fall in the category of work environment (Butts and Karen 10). Nurses often report that they lack time to attend to patients as intended, that is, help them to adapt, recover or even addressing their emotional needs. Nurse practitioners feel that the health care system does not recognize any of the moral obligations for curing patients. Therefore, nurses feel that most of the times they do not offer patients the needed optimal care.
Most nurses are distressed by the numerous challenging ethical issues in their practice. Nurses encounter ethical challenges in situations, where what they think is right, sometimes is not always the case resulting in moral distress. Nurses have a moral burden of witnessing sufferings of their patients. However, it is their duty to balance the suffering, the benefit, and complexity of their decisions. Specifically, it is part of nursing to witness the relief of suffering, but sometimes interventions may cause patients to suffer more in the process of restoring health. In most cases, distress results in negative impacts on the nursing practice. Some of the consequences of distress are an increased burnout, job attrition, decreased quality of patient care and decreased job satisfaction (Chernecky and Kathleen 174-175). Therefore, dealing with ethical issues ought to be the foremost concern for nursing leadership. Principles of nursing have guidelines that nurses can use to base their ethical decisions. However, nurses have to balance the knowledge with experiences, values, and beliefs.
The nurse managers have the responsibility of working towards resolving ethical problems. More so, they have to support ethical decision making of their subordinates. The most important role for nurse managers is to ensure proper application of ethical principles. They have to create working environments that support high ethical standards. The nurse managers need to integrate core values and ethical standards into daily nursing practice. A significant role of ethical nursing management is to ensure that nurses protect the interests of their patients while administering quality care. Nursing programs have to prepare graduate and undergraduate students for clinical practice (Chernecky and Kathleen 176). It is the duty of nurse managers to put ethical resources in place. Every health institution needs an ethics committee that encourages nurses to voice their concerns. The institutions can provide unit-based ethics mentors to help nurses in facing the issues.
Nurses have to reflect on the way they manage competing obligations in the workplace. Team members have to balance tasks by resetting priorities as patients arrive. In terms of genomics and genetics, the technology ought to be available to all patients. Education on genetic testing technology is essential for nurses to appropriately deal with ethical issues. Ongoing education on ethics is one of the ways of dealing with distress. Education is crucial in ethical competence and creation of strong common basis for ethical thinking in nursing management and practice. Both the society and health care organizations need to engage in an extensive discussion on health care values. On the other hand, health care institutions must incorporate job descriptions with behavior that is consistent with the nursing code of ethics (Masters 117). Furthermore, some nursing organizations have position statements that deal with ethical issues that nurses can use as a guide.
Good and quality care is dependent on many factors that include organizational culture and competencies. Finding ways to deal with ethical conflicts is vital not only to nurses but also to health institutions striving to improve their outcomes. Evidently, moral distress affects patient care as it is associated with job turnover and employee burnout. However, there are several strategies that organizations can use to address ethical issues that the nursing people face to reduce their moral distress. First, it is by supporting the nursing code of ethics. The code of ethics presents a framework for nursing practice. Nurses need to be familiar with the code and use it to make decisions. The second strategy is ongoing education, where educational programs include ethics content. New employee orientation should include theoretical principles that deal with ethical issues. Creating an environment for nurses to voice their concern is the third strategy. Ethical issues are complex, and everyone’s voice is important in exchanging experiences and values to deal with the situation. The fourth strategy is bringing different disciplines together. Nurses and physicians experience similar suffering (Masters 114-116). Therefore, working together can prove to be beneficial mostly in addressing the increasing moral distress. The fifth strategy is providing nurses with an ethics expert.
Counseling for nurses troubled by some ethical issues may improve their performance in work. Professional associations have to provide resources that can assist the nursing fraternity in handling ethical issues. Associations, such as ANA, need to publish more articles on ethical issues online and make them available at no cost. The journals on nursing ethics are equally important to nurses as they are dedicated to the topic. Reading articles on the ethical dilemmas that other nurses have experienced can help others in dealing with ethical problems. More information is required together with concrete mechanisms on the manner, in which decisions are to be made for ethically problematic solutions (Fierz et al. 272-273). What’s more, the code of the nursing profession seemingly have limited value in resource allocation. Therefore, clear guidelines are inevitable for nursing management personnel to aid in ethical decision-making.
In conclusion, the paper deals with ethical dilemmas that nurses face in their daily practice. Through all the ethical dilemmas the nurses face, they must make decisions. Nevertheless, many factors affect these decisions. The principles learned in nursing college, personal values, beliefs, and experiences play the major part in making either right or wrong choice. The study has provided an overview of some of the ethical problems the nursing management encounters. The paper indicates that resource allocation as well as quality of care is part of the source for ethical problems. Nonetheless, a research is needed to find principles, values, and codes to guide nurses in making solutions to ethical problems.